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Applying for Medicaid in Florida

Medicaid Eligibility, Qualifications and Application


Doctor examining girl (10-11)
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Medicaid provides low income Florida families with free or low-cost medical insurance to provide a basic level of medical care to all Florida residents. Applying for Medicaid is a fairly complex process, requiring different steps based upon the manner in which you qualify. Some require the involvement of only the state government, while others involve the federal Social Security Administration. In this article, I break down the process step-by-step to make it simple for you and your family to get Medicaid coverage.

Medicaid Eligibility

Medicaid coverage is available to individuals and families who fall into at least one of the following five categories:
  • Low income families with children
  • Child-only coverage
  • Pregnant women
  • Non-citizens with medical emergencies
  • Aged or disabled individuals
The eligibility requirements for individuals in each category are quite different, as are the application procedures. Be sure to read the relevant section(s) below to learn more.

Medicaid Qualifications for Low Income Families with Children

Florida families with children may qualify for Medicaid coverage if they meet the following requirements:
  • Family income below the limits for Temporary Cash Assistance (TCA). In 2011, the limit is $364 for a family of four and increases approximately $62 for each additional family member. For more details see the TCA eligibility chart.
  • Countable assets less than $2,000 (excluding your homestead)
Families receiving TCA payments are automatically eligible for Medicaid. Also, if you receive Medicaid and become disqualified due to earned income, you may remain eligible for up to 12 additional months. You may apply for Medicaid for Low Income Families with Children using the ACCESS Florida online application.

Medicaid Qualifications for Children Only

If your entire family does not qualify for Medicaid coverage, you still may be able to obtain coverage for your children (under 19) only. Children who are US citizens and Florida residents qualify if they meet one of the following requirements: You may apply for Medicaid for Children Only using the ACCESS Florida online application.

Medicaid Qualifications for Pregnant Women

Pregnant women have several options for receiving Medicaid coverage:
  • The quickest way is the Presumptive Medicaid Eligibility for Pregnant Women (PEPW) process. To obtain this coverage, your family income must be less than 185% of the federal poverty guidelines. You apply for this coverage in person at a public hospital, the county health department or state-approved healthcare providers. It is only good for 60 days and is designed to provide you access to care while you apply using the SEPW process.
  • You may obtain longer-term coverage using the Simplified Eligibility for Pregnant Women (SEPW) process. You must provide proof that your income is less than 185% of the federal poverty guidelines, that you are a US citizen, and that you are pregnant. To apply for this coverage, fill out the one-page SEPW application.
  • You may apply for Medicaid for Low Income Families with Children using the ACCESS Florida online application.

Medicaid Qualifications for Non-Citizens with Medical Emergencies

Non-citizens are not eligible for standard Medicaid coverage. However, non-citizens who are not in the US for a temporary reason (such as vacation or business travel) are eligible to receive Medicaid coverage for emergency care only. For more information, contact the Florida Department of Children and Families.

Medicaid Qualifications for Aged or Disabled Individuals

In Florida, individuals receiving SSI payments from the Social Security Administration are automatically eligible for Medicaid coverage. The SSI application is also your application for Medicaid benefits.

Other Benefits for Low Income Families

Low income families who are eligible for Medicaid may also wish to investigate their eligibility for two other government programs: food stamps and unemployment benefits.
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